Issued also as Thesis (Ph. D.)--Marquette University. / "Select bibliography": p. [199]-217.

Thesis (Ph. D.)--Marquette University, 1940. / Published also without thesis note. "Selected bibliography": p. [199]-217.

Background: Determination of intra-abdominal injury following blunt abdominal trauma (BAT) continues to be a diagnostic challenge. Ultrasound (US) bas been described as a potentially useful diagnostic tool in this setting and is being used with increasing frequency in trauma centers. We determined the diagnostic capability of US in the evaluation of BAT. Methods: A retrospective analysis of our trauma US database was performed over a 30-month period. Computed tomographic scan, diagnostic peritoneal lavage, or exploratory laparotomy confirmed the presence of intra-abdominal injury. Results: During the study period, 8,197 patients were evaluated at the Ryder Trauma Center. Of this group, 2,576 (31%) had US in the evaluation of BAT. Three hundred eleven (12%) US exams were considered positive. Forty-three patients (1.7%) had a false-negative US; of this group, 10 (33%) required exploratory laparotomy. US had a sensitivity of 86%, a specificity of 98%, and an accuracy of 97% for detection of intra-abdominal injuries. Positive predictive value was 87% and negative predictive value was 98%. Conclusion: Emergency US is highly reliable and may replace computed tomographic scan and diagnostic peritoneal lavage as the initial diagnostic modality in the evaluation of most patients with BAT.

Ureteral injuries although rare can cause serious issues. The mechanism of injury is most commonly penetrating but in some rare cases blunt forces can contribute. It is important to diagnose ureteral injuries as soon as possible because they can have significant morbidity and mortality. Here we present two cases of isolated ureteral injury secondary to blunt force trauma. Both patients had the ureteral injury diagnosed by computed tomography (CT) scan and confirmed by a ureterogram with extravasation of contrast. Both patients also had peripelvic cyst, which could have been a contributing risk factor for injury. In both cases, the ureteral injury was repaired using a stent and both patients had no complications. We present these cases along with presentation, diagnostic work-up, and treatment.

No description available.

Various traumatic events such as automobile accidents, structure fires, or terrorist attacks result in traumatic and thermal injury. Fire is a destructive force that can alter or destroy evidence, and thermal alterations have negative effects on forensic and anthropological recovery and analysis. Blunt force trauma is particularly difficult to analyze because of the multiple ways in which this trauma appears on a body and the variety of objects that can impact and fracture a bone or the variety of ways a body can impact a blunt surface. As fire is a common way to cover up a crime and blunt force trauma is used as a means to kill or injure an individual, it is necessary to understand the differences between these two types of fractures that can present together on bone. The present study was performed to determine the amount of survivability of traumatic fracture patterns in remains that have been exposed to a burning event. The sample used for this investigation was composed of twenty limbs (forty long bones) from five full-grown, domestic, female sheep (Ovis aries) obtained from a farm in Connecticut. Thirty specimens were traumatized with the head of an Estwing ball peen hammer and ten were left as controls. After specimens were subjected to blunt force trauma, each was radiographed using Computed Tomography. They were then placed in a small structure, 8' x 8', that was constructed to simulate the conditions of a house fire. Each post-burn bone was analyzed based on a number of characteristics. A trauma score of "1" no trauma, "2" ambiguous, and "3" traumatic fractures were given based on these observations. CT scans were examined after bone samples had been analyzed. Again, each specimen's CT scan was given a trauma score ("1" no trauma, "2" ambiguous, and "3" traumatic fractures). Results from the bone analysis on the 30 traumatized and burned specimens revealed that 15 did not have trauma, 2 were ambiguous (i.e., they may have trauma but traumatic characteristics were not distinct), and 13 presented with distinguishable traumatic injury. Comminuted was the most prominent type of fracture, and the next most common fracture was oblique. The majority of traumatic injury was found on the middle portion of the bone. CT examination showed that 12 specimens had suffered traumatic injury. The two analyses were compared and showed an agreement of 83.3% between the trauma scores. Results show that differentiation of traumatic and thermally induced fractures is possible using various fracture characteristics as well as taphonomic indicators to determine the sequence of events.

Le travail de la thèse porte sur une étude globale des interactions qui surgissent sur le système projectile/protection/cible lors d’un impact balistique non perforant. L’objectif principal consiste à l’analyse et à l’évaluation des modes d’endommagement des projectiles et des protections d’une part, et les déformations occasionnées sur la cible, d’autre part. Une étude expérimentale a permis la caractérisation mécanique des différents matériaux utilisés à savoir : la gélatine, la plastiline, ainsi que l’analyse des réponses balistiques utilisant des protections en composite, en aluminium et textiles. L’accent a été mis sur la recherche des lois de comportement appropriées pour les différents composants du système balistique utilisant des multi-matériaux. Une simulation numérique du thorax humain a été développée, exploitée et validée sur la base d’un impact non pénétrant. La simulation numérique a été réalisée en prenant en compte à la fois le thorax et les différents organes du corps humain en intégrant aussi la présence de protections. / This work deals with interactions occurring on the projectile/protection/target system during a non-perforating ballistic impact. The first main goal concerns the analysis and evaluation of the processes’ damage projectiles and protections. The second one concerns the deformation of the target. An experimental study has allowed the mechanical characterisation of different used materials: the gelatine, the plastilina, and the analysis of the ballistic response of the composite, aluminium and textile based-protections. The research carried out here is focused on the appropriate material laws of different components of the ballistic system implicating the multi-materials. A numerical simulation of the human thorax has been developed, implemented and validated thanks to a non-penetrating ballistic impact. The numerical simulation has been realised by taking into account of both the thorax and the different organs of the human body protected by a ballistic protection.

Cardiac-specific troponins (Tns) are sensitive and specific markers of myocardial injury that have been shown to be predictive of outcomes in many cardiac and noncardiac conditions. We sought to determine whether normal cardiac Tn concentrations obtained during the first 24 hours following blunt chest trauma would predict good cardiac outcomes. A PubMed/MEDLINE search was performed to identify prospective studies in patients with blunt chest trauma in which serial cardiac TnT or TnI values were measured within 24 hours of admission and clinical outcomes assessed. Ten studies qualified for review. Studies that used the lower reference limit of Tn as the cutoff for cardiac injury showed 100% negative predictive value (NPV) for developing cardiac complications, whereas studies using higher Tn cutoffs showed wider variation in NPV (50%-98%). Cardiac Tn measured within 24 hours using the lower reference limit (LRL) as the cutoff appears to have excellent NPV for clinically significant adverse cardiac events. This could allow for early discharge after a 24-hour observation period in otherwise uncomplicated blunt chest trauma patients and avoid the need for more expensive cardiac imaging and additional resource utilization.

No description available.

The research presented in this thesis investigates eye injuries caused by blunt impacts and blast overpressure. This research represents part of an ongoing investigation to accurately quantify and predict eye injuries and injury mechanisms for various loading schemes. It has been shown that blunt trauma can cause severe eye injuries but it remains undecided whether blast overpressure alone can cause eye injury. Presented herein are four experimental studies that quantify eye injuries and implement a technique for predicting injury risk. Isolated porcine or human eyes were subjected to various loading conditions consisting of blunt projectiles, water streams, remote control helicopter blades, and blast overpressure. All eyes were prepared in a similar manner that required the insertion of a miniature pressure sensor into the globe through the optic nerve. This sensor measured intraocular pressure throughout each event. Using previously published injury risk curves, this intraocular pressure data was used to predict the injury risk for four eye injuries: hyphema, lens damage, retinal damage, and globe rupture. Injuries sustained were quantified upon direct inspection of the globe following testing. No serious eye injuries were observed for any of the tests and all tests resulted in low predicted injury risks consistent with the lack of observed injury. The research presented in this thesis provides a robust low injury level dataset for eye injuries. This data could be useful for designing and validating computational models and anthropomorphic test device eyes, and serves as a basis for future work with more dangerous projectiles and higher pressure levels. / Master of Science